Recently there has been a lot of buzz about the effectiveness of using clinical decision support (CDS) to promote appropriate ordering of advanced imaging exams—especially since RAND released the results of the Medicare Imaging Demonstration (MID) late last year. The demonstration was a CDS pilot program designed by CMS—and the results weren’t encouraging.

But we need to understand more about the study before we jump to conclusions based on what’s been the news. Significant flaws in the design and limitations in methodology impact how we should interpret these results.

A research team, headed by Dr. Timothy Amrhein of the department of radiology and radiological science at the University of South Carolina, found that physicians with a financial interest in the MRI equipment being used do have a bias toward increase utilization. The study supports the Obama administration’s proposal to restrict the in-office ancillary services exception to the Stark Law.

The SGR has driven CMS to slash reimbursements in an effort to aggressively reduce spending. Imaging has been under the microscope as a source of health system waste, experiencing aggressive rate cuts as much as 25% as a result. The new bill shows the promise of relief.

Ben Lauing, Imaging Performance Partnership

President Obama’s proposed budget may signal major reforms in store for imaging. Self-referral, an issue often debated but rarely acted upon, is now an explicit target; the Obama administration has proposed restricting the in-office ancillary services exception to the Stark law. Furthermore, the budget suggests mandatory pre-authorization for advanced imaging modalities.

While this is only a proposed budget, and Congress could take it or leave it, we think it’s highly likely that regulations to curb imaging utilization will soon emerge.

A report last week from the Government Accountability Office (GAO), the nonpartisan investigatory and auditing agency for Congress, found that in 2010 providers for advanced imaging services made close to 400,000 more referrals than they otherwise would have if they had not held a financial interest in the imaging equipment.

Michael Song, Imaging Performance Partnership

Fourteen health care practitioners across New Jersey were arrested this week on charges of participating in a bribery scheme to steer patient referrals to a community MRI center. The arrests follow an investigation by the Office of the Inspector General that uncovered bribes made by directors at the Orange Community MRI Center to referring physicians.

In a study published this month by the American Journal of Roentgenology, Bhargavan and colleagues found new quantitative evidence to support what many have long suspected – that self-referring physicians image at a much higher rate than physicians with no financial interest at stake. While many prior studies have attempted to shed light on how financial interest can affect imaging utilization, several popular critiques have dampened earlier studies’ persuasiveness. What makes this study unique in the eyes of its authors, then, is not the result, but the methodology.